Individual
RONALD E WIISANEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2400 32ND AVE S, FARGO, ND 58103-5800
(701) 234-8866
Mailing address
2400 32ND AVE S, FARGO, ND 58103-5800
(701) 234-8866
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4277
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0109660
MEDICA
—
01
—
1008280
PREFERREDONE
—
05
—
10404
—
ND
01
—
22254
ND BCBS
ND
01
—
22G06WI
MN BCBS
MN
05
—
952383900
—
MN
01
—
HP20680
HEALTHPARTNERS
—
Enumeration date
08/05/2006
Last updated
12/13/2011
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